Lecturer name: Prof Hanan Habib & Prof. A.M. Kambal Department of Pathology, Microbiology Unit,KSU

1. Lecture Title: NORMAL FLORA (Foundation Block, microbiology) Lecturer name: Prof HananHabib & Prof. A.M. Kambal Department of Pathology, Microbiology Unit,KSU

2. Lecture Objectives • By the end of this lecture the student is expected to be able to: • Define the terms: Normal Flora, Resident flora, Transient flora and carrier state • Know the origin of normal flora. • Know the importance of normal flora with examples, including importance as: • Source of opportunistic infection. • Immunostimulation. • Nutrition: Vitamins production. • Production of Carcinogens. • Protection against external invaders. • Know areas of the body with normal flora (GIT, Urogenital tract, and skin) and most common types of organism in these areas and relation to pathogenicity of these organism. • Know sites of the body with no normal flora e.g. sterile body sites and the importance of this fact in relation to interpretation of culture results.

3. Definition • Normal flora are microorganisms that are frequently found in a particular site in normal healthy individual. • Some are found in association with humans / animals only. The Majority are bacteria. • Symbolic relationship with the host. • Subject to constant changes. • Altered by antimicrobial agents.

4. Types of Normal Flora • Commensals:natural relationship with host. • Residents: present for invariable period . • Transients: establish itself briefly , excluded by host defence or competition from residents. • Carrier state: potentially pathogenic , eg. S.pneumoniae, N. meningetidisin throat of healthy individual.

5. Origin of Normal Flora • Newborn sterile in utero. • After birth ,exposed to flora of mother’s genital tract, skin, respiratory tract flora of those handling him ,and organisms in the environment.

6. Beneficial effects of normal flora • 1- Immunostimulation(antibody development) • 2- Exclusionary effect (vacuum effect ) and protection from external invaders. • 3-Production of essential nutrients (vit. K & Bby some normal intestinal flora eg. E.coli.

7. Other facts regarding normal flora • May be a source of opportunistic infections. eg . In patients with impaired defense mechanisms. egS.epidermidis, E.coli. • Some may cross react with normal tissue components,eg, antibodies to various ABO group arise because of cross reaction between intestinal flora and the antigens of A &B blood substances.

8. Continue • Production of carcinogens: • Some normal flora may modify through their enzymes chemicals in our diets into carcinogens. eg. artificial sweeteners may be enzymatically modified into bladder carcinogens.

9. Distribution of normal flora • Internal organs(except alimentary tract) are sterile at health. • Sterility maintained by : • - local defence mechanisms • - chemical substances in serum & tissues eg. Complement , antibodies. • -phagocytic activity of PMN

10. Areas of the body with normal flora • GIT: mouth & large colon • Urogenital tract : vagina & distal 1/3 of the urethra • Skin

13. Normal flora of the respiratory tract • Upper resp. tract colonizes by flora as in mouth & nasopharynx • Lower respiratory tract is sterile • Nose: - Staph. epidermidis • - Staph. aureus • -Corynebacteria

14. Oropharynx flora • Viridance streptococci • Commensalneisseriae • Corynebacteria • Bacteroides • Fusobacteria , Veillonella, actinomyces, spirochaetes. • Heamophilusinflenzea & Pneumcoccus are potential pathogens. • Less common: S.pyogenes , N.meningitidis

15. Gastrointestinal tract flora • Saliva contains 108bact/ml • Gingival margin debris &dent. Plaque continually colonized by bacteria. • Oesophyagusflora as pharyngeal flora. • Empty stomach sterile due to gastric acid. • Duodenum, jejunum & upper ileum have scanty flora • Large intestine heavily colonized by bacteria.

16. Faeces • 1/3 of faeces wt. is bacteria , mainly dead, • Living bacteria ~ 1010/gm • 99% anaerobes • Anaerobic environment maintained by aerobic bacteria utilizing free O2. • Bacteroides fragilis group the dominant anaerobes, Bifidobact. Lactobacilli…etc. • Less common: E.coli ,Proteus,….etc.

17. Genital tract flora • Female genital tract heavily colonized , why ? • 108/ml in normal vaginal secretion. • In both sexes Mycobacterium Smegmatis(AFB) ( acid fast bacilli) in secretions which contaminate urine-leads to confusion /misdiagnosis. • M & F distal urethra: - S.epidermidis • - Corynebacteria • -Mycoplasma.

18. Female Vulva • S. epidermidis , corynebacteria, E.coli and othe coliforms & Enterococcus faecalis. • Vagina : • -Lactobacilli (Doderlein’s bacilli) • - Bacteroides melaninogenicus • -Enterococcus faecalis • - Corynebacteria • -Mycoplasma • - Yeasts.

19. Normal Skin Flora • Skin has rich resident bacterial flora(104/cm2). • Exist as microcolonies. • Anaerobic organisms predominate in aereaswith sebaceous glands. • Moist skin ,often colonized by coliforms.

20. Main Skin Flora • Propionibacterium acnes • Anaerobic cocci • S. epidermidis • Corynebacteria • S. aureus(less common, potential pathogen) • Coliforms

21. External auditory meatus • S. epidermidis • Corynebacteria • AFB ( Acid Fast Bacilli)occasionally in wax. CONJUNCTIVAL SAC FLORA • -Corynebacteriumxerosis • - S.epidermidis

22. Reference book and the relevant page numbers. • SHERRIS MEDICAL MICROBIOLOGY, AN INTRODUCTION TO INFECTIOUS DISEASES. KENNETH RYAN /GEORGE RAY. LATEST EDITION. PUBLISHER MC GRW HILL. • CHAPTER 9, PAGE 141-148

23. Thank You  (Foundation Block, Microbiology) Prof HananHabib & Prof. A.M. Kambal